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IPAP > GI: Diarrhea - Ascites > Flashcards

GI: Diarrhea - Ascites Flashcards

1
Q

PTs may define diarrhea as ?

A

Frequent, more than 3/day
Loose, watery
Urgency

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2
Q

What is the criteria for persistent diarrhea

What is the limit for chronic diarrhea?

A

Diarrhea lasting between 2 and
4 wks
+4 wks

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3
Q

What are two important considerations in the work up for diarrhea?

A

Acute vs Chronic

Non vs Inflammatory

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4
Q

Etiology of acute diarrhea

A

Are these present?
Severe illness (<7days; Fever, Pain, Bloody diarrhea, +6 BMs/24hr, Dehydration)
Immunocompromised
Elderly +70yrs

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5
Q

What is the next step for treating acute diarrhea if the severe illness, immune compromise of non-elderly criteria are NOT met?

A

Sx therapy: anti-diarrhea- loperamide, bismuth subsalicylate

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6
Q

What is the next step when treating acute diarrhea and the severe illness, immune compromise of non-elderly criteria are ARE met or illness is present after 7-10 days after Sx therapy?

A 
Stool sample for:
Fecal leukocyte
Routine stool culture
C Diff
Ova/parasite testing- if travel, +10day, water outbreak, relationship criteria is met
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7
Q

Acute diarrhea meeting severe illness/immune/elder criteria or or lasting 7-10 days after Sx therapy will have stool samples tested for ova/parasite. Empiric ABX therapy is considered while waiting culture if ?

A 
\+ fecal leukocyte
Bloody diarrhea
Fever
Ab pain
Dehydration/ +8 BMs/24hrs
Immunocompromised
Hospitalization REQ'D
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8
Q

Acute diarrhea lasting less than 2wks is most commonly caused by ?

A

Acute non-inflamm: virus, non-invasive bacteria

Acute inflamm: invasive or toxing producing bacteria

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9
Q

Characteristics of acute inflammatory diarrhea?

A

Blood, pus or fever
Invasive/toxin producing bacteria
Stool cultures: E Coli O157:H5 and O157:H7, C Diff and Ova/parasite

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10
Q

What are the Viral causes of noninflammatory diarrhea?

A 
Norovirus*
Rotavirus*
Astrovirus
Adenovirus
Sapovirus
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11
Q

What are the Protozoal causes of non-inflammatory diarrhea?

A

Giardia*
Crytposporidium
Cyclospora

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12
Q

What are the bacterial causes of non-inlfammatory diarrhea?

A

Preformed enterotoxins= Staph A, Bacillus Cereus, Clostridium Perfringens
Enterotoxin production= E Coli ETEC, V Cholera, Vibrio Vulnificus

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13
Q

What are the viral and protozoal causes of inflammatory diarrhea?

A 
V= cytomegalovirus
P= entamoeba histolytica
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14
Q

What are the bacterial causes of inflammatory diarrhea?

A

Cytotoxin producing- EHEC H5/H7, V parahaemolyticus, C Diff
CYCLASES PY
Mucosal invasion= Shigella, C Jejuni, Salmonella, EIEC, Aeromonas, Plesiomonas, Yersinia entercolitica, Chlamydia, N Gonorrheoae or Listeria Monocytogenes

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15
Q

What are the relevant Hx facts for acute diarrhea?

A 
Bloody vs watery (nonbloody)
Recent travel
Diet/new places
ABX use
Sick contacts
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16
Q

What are the essentials of Dx for non-inflammatory diarrhea?

A 
Duration less than 2wks
Watery, non bloody
Mild, self limited
Virus/non invasive bacteria
SMALL Bowel
Dx eval only if severe/+7 days
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17
Q

What are the common etiologies of non-inflammatory diarrhea?

A

Viral- Norovirus, Rotavirus

Protozoa- Giardia (water park)

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18
Q

What are the S/Sx of non-inflammatory diarrhea?

A 
Loose water stool
10 bm/day
Cramps
Bloat
N/V
Signs of dehydration- dizzy, light headed, OHOTN
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19
Q

What are the essentials of Dx for Acute Inflammatory diarrhea

A

Less than 2wks
Blood, pus, or fever usually caused by invasive/toxin producing bacteria in
LARGE bowel

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20
Q

What does diagnosis evaluation require for Acute Inflammatory Diarrhea?

A

Routine stool culture for E Coli O157:H7

Testing is indicated for C Diff and parasite/ova

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21
Q

What are the common etiologies of Acute Inflammatory Diarrhea?

A

E Coli
Shigella
Salmonella
C Diff- if recent ABX use

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22
Q

What are the Sx of Acute Inflammatory Diarrhea?

A

Loose bloody stools but lower in vol
Fever and severe LLQ pain
Tenesmus

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23
Q

What are the Signs of Acute Inflammatory Diarrhea that prompt evaluation?

A 
Signs of inflammatory diarrhea: fever, WBC +150K, Blood diarrhea w/ severe ab pain
Frail elderly/nursing home PT
Immunocompromised
Nosocomial, onset in 3 days
ABX exposure
Systemic illness
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24
Q

What are the evaluation steps for Non/Inflammatory Diarrhea?

A

Non= Self limited and mild
Labs usually not req’d unless persists +7 days or constant/severe dehydration

Inflammatory= prompt eval for ALL cases

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25
Q

If PT presents with acute diarrhea, what findings/signs prompt a immediate/further evaluation?

A

Peritoneal findings present with W Diff or STEC

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26
Q

What are the lab tests needed for acute diarrhea?

A

Fecal leukocytes- will be neg in non-inflammatory PTs
Stool culture- OP, 3 samples needed
C Diff if recent ABX use
Fecal Lactoferrin- marker for intestine inflammation

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27
Q

What are the general treatment strategies for acute diarrhea?

A 
BRAT
Avoid high fiber foods, fats, dairy and caffeine
Re-hydrate
PO liquids
Oral rehydration salts
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28
Q

What pharmacotherapy is recommended for acute diarrhea PTs?

What is the down side/consideration for these?

A

Antidiarrhea
Loperamide
Bismuth subsalicylate
Used to allow PT to continue work/mission, works AGAINST the body’s mechanisms

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29
Q

When are ABX considered to be given to Acute Diarrhea PTs?

A

Not always indicated
Non-hospital acquired diarrhea w/ mod/severe fever, tenesmus or bloody stool, or presence of fecal lactoferrin
Immunocompromised PTs
Significant dehydration

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30
Q

Emipiric treatment may be considered for what acute diarrhea PT while their stool cultures are growing?

A 
Non-hospital acquired diarrhea w/ mod/severe fever
Tenesmus 
Bloody stool
No STEC suspicion
Immunocompromised PTs
Significant dehydration
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31
Q

What is the pathophysiology of Traveler’s Diarrhea

A

Most commonly from ETEC in PTs w/ Hx of recent travel that presents w/ abrupt, watery diarrhea, cramping and nausea w/in 10 days of return

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32
Q

How is Traveler’s Diarrhea managed?

ETEC most commonly caused S/Sx

A

Rehydrate, Cipro, Azithromycin- if pregnant

Diarrhea, Ab cramping, Nausea, Bloating

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33
Q

What ABX are used for empiric treatment for acute diarrhea?

A 
Fluoroquinolones are DOC
Ciprofloxacin 500mg BID 
Ofloxacin 400mg BID
Levofloxacin 500mg QD
All for 5-7days 
Others:
Trimethoprim-sulfamethoxazole 160/800mg BID
Doxycycline 100mg BID
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34
Q

Are ABX recommended for Traveler’s Diarrhea?

A

Diarrhea onset w/in 10 days of return- ABX can shorten duration by days
Rx can also be given to PTs prior to travel

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35
Q

What meds are given for inflammatory Traveler’s Diarrhea?

A 
PO DOC for empiric treatment:
Ciprofloxacin 500mg
Ofloxacin 400mg or, 
Levofloxacin 500mg 1/day for 1-3 days
Alternatives= Trimethoprimsulfamethoxazole 160/800mg BID
Doxy 100mg BID
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36
Q

What meds are used for Inflammatory Traveler’s Diarrhea non-empirically?

A

Fluoroquinolones- 3 day course but not useful in SE Asia
Azithromycin 1 g single dose
Rifaximin 200mg TID x 3 days

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37
Q

Fluoroquinolones, Azithromycin and Rifaximin are specific treatments for Inflammatory Traverl’s Diarrhea that are caused by what microbes?

A 
Shigellosis
Cholera
Extraintestinal Salmonellosis
Listeriosis
Traveler's D
C Diff
Giardia
Amebiasis
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38
Q

What meds are used for non-inflammatory Traverl’s Diarrhea?

A

Rifaximin- 200mg BID x 3 days and Azithromycin 1g single dose or 500mg daily x 3 days for EMPIRIC treatment

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39
Q

When are PTs with Traveler’s Diarrhea considered for admission?

A

Severe dehydration of IV fluids especially if intolerable to PO fluids
Bloody diarrhea
Severe ab pain
Fever +39.5*C or sepsis
+70 y/o or immunocompromisesd w/ worsening diarrhea
S/Sx of hemoytic-uremic syndrome

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40
Q

What PO fluids are recommended for Traveler’s Diarrhea rehydration?

A 
Water
Gatorade
Tea
Flat carbonated beverages
Or re-hydration salts if necessary
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41
Q

When considering chronic diarrhea, what exclusions must be ruled out?

A 
Causes of acute
Lactose intolerance
IBS
Previous gastric surgery/ileal resection
Parasitic infection
Meds
Systemic Dz
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42
Q

What labs/tests are done for a chronic diarrhea PT?

A

Fecal leukocytes and occult blood
Colonoscopy with biopsy
Small bowel imaging with barium, CT or MRE

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43
Q

What does it mean if chronic diarrhea labs/tests come back abnormal?

A

Inflammatory bowel dz

Cancer

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44
Q

What is the next step if chronic diarrhea labs/tests come back abnormal?

A

Stool E+, osmolality, weight/24hrs and quantitative fat

ALMOST ALL CASES REFERRED TO GI

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45
Q

What are the next steps/considerations if chronic diarrhea PT has an increased osmotic gap?

A

Inc fecal fat= malabsorption, pancreatic insufficiency or bacterial overgrowth

Norm fecal fat= lactose intolerance, Sorbitol/Lactulose laxative abuse

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46
Q

What are the next steps/considerations if chronic diarrhea PT has a normal osmotic gap?

A

Normal stool weight= IBS or factitious diarrhea

Inc weight= secretory stool weight

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47
Q

For diarrhea to be considered “chronic”, it must be present for how long?
What are the common causes that must be immediately ruled out?

A

Longer than 4wks

Meds
Chronic infections
IBS

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48
Q

What are causes of chronic diarrhea?

A 
Osmotic/secretory diarrhea
Inflammation conditions
Meds
Malabsorption syndromes
Motility disorders- IBS
Chronic infections
Systemic disorders
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49
Q

What are the Hx questions for Chronic Diarrhea?

A 
Continuous / intermittent
Relation to meals
Nightly occurence?
Fasting occurence?
Appearance
Ab pain/cramping
Meds
Weight loss
Stressors
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50
Q

What are the most common causes of chronic diarrhea and need to be ruled out prior to work up?

A

Meds
IBS
Lactose intolerance

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51
Q

What findings/Sx are inconsistent with the most common causes of chronic diarrhea and warrant further evaluation?

A

Nocturnal diarrhea
Weight loss
Anemia
Pos FOBT

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52
Q

What is the first part of the work up for chronic diarrhea?

A

Exclude most common causes (Med, LI, IBS)

Evaluation directed at most likely etiology based on Sx and Hx

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53
Q

What are the lab tests for Chronic Diarrhea?

A 
CBC
Chem 17
LFT
Thyroid studies
ESR
CRP
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54
Q

What stool studies are ordered for chronic diarrhea?

A 
Culture
Leukocytes
Lactoferrin
Occult blood
O&amp;P
E+
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55
Q

Why is a colonoscopy with biopsy warranted for a chronic diarrhea PT?

What are the “other” tests that can be ordered?

A

Exclude IBD and neoplasm

24hrs stool collection- total weight/total fat

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56
Q

What are the clues for Osmotic Diarrhea

A

Stool volume decreases w/ fasting

Increased osmotic gap that resolves with fasting

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57
Q

What are the etiologies for osmotic diarrhea?

A

*Carbohydrate malabsorption- consider in all Pts w/ chronic posprandial diarrhea, ask about dairy/artificial sweetener intake
Lax abuse
Malabsorption syndrome

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58
Q

How is Osmotic Diarrhea identified?

A

Elimination trial: Laxative abuse, malabsorption

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59
Q

Diagnosis of carb malabsorption can be established after how long of an elimination trial?

A

2-3 wks or,

H breath test

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60
Q

What are the most common causes of Osmotic Diarrhea?

A

Carbohydrate malabsoprtion- lactose, fructose, sorbitol
Laxative abuse
Malabsorption syndromes

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61
Q

Osmotic diarrhea resolve during ___ and are characterized by ?

A

Resolve during fasting

Characterized by- abnormal distension, bloating, and flatulence from inc colonic gas

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62
Q

What is the definition/criteria for Secretory Diarrhea?

A

+1L/day
Normal osmotic gap that doesn’t change w/ fasting
Inc intestinal secretion and/or decreased absorption

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63
Q

What are the etiologies of Secretory Diarrhea?

A

Endocrine Tumors

Bile Salt malabsorption

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64
Q

What are the clues of inflammatory chronic diarrhea?

A

Fever
Hematochezia
Ab pain

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65
Q

What are the causes of inflammatory diarrhea?

A

IBDz- Crohn’s, Ulcerative colitis
Microscopic colitis
Malignancy- lymphoma, adenocarcinoma

66
Q

What types of meds can cause chronic diarrhea?

A 
SSRs
NSAIDs
PPIs
ARBs
Metformin
Allopurinol
67
Q

What are the clues for malabsorption from diarrhea?

A

Weight loss
Fecal fat >10g/24hrs
Abnormal labs

68
Q

What are the clues of motility diarrhea?

A

Systemic dz or ab surgery
Systemic= DM, scleroderma, hyperthyroid, IBS

Pain/altered bowel habis w/o evidence of organic dz

69
Q

What are the clues for chronic diarrhea?

A

Parasites or AIDS
Parasites= Giardia, E Histolyitca, Cyclospora or intestinal nematodes
Systemic= Thyroid Dz, Diabetes

70
Q

Define Factitious Diarrhea

A

Osmotic diarrhea subset from magnesium (laxatives and anti-acids)

71
Q

What are the initial diagnostic tests for chronic diarrhea in order of sequence?

A

Routine lab tests
Routine stool studies
Endoscopic exam

72
Q

What are the lab tests ordered for chronic diarrhea?

A 
CBC
Serum E+
Liver chemistry
Ca, PO4
Albumin
TSH
Vit A and D levels
INR, ESR, CRP
73
Q

Most PTs with chronic diarrhea and ALL pts with signs of malabsorption receive what lab test?

A

Celiac Dz- IgA tissue transglutaminase

74
Q

Anemia can occur in which malabsorption syndromes?

A

Folate
Fe deficiency
Vit B12
Inflammatory conditions

75
Q

Hypoalbuminemia is present in what conditions?

A

Malabsorption
Protein-loss enteropathies
Inflammatory dz

76
Q

Hyponatremia and nonanion gap metabilic acidosis occur in what type of diarrheas?

A

Secretory

77
Q

Inc ESR or CRP suggests what GI issue?

A

Inflammatory bowel disease

78
Q

What are stool samples examined for during a chronic diarrhea PTs?

A 
Ova/parasites
E+
Sudan stain for fat
Occult blood
Leukocytes/lactoferrin
79
Q

Cryptosporidia, Giardia, E Histolytica and Cyclospora may be diagnosed how?

A

Stool Ag or,

Microscopy

80
Q

Pos fecal fat stain indicates what?

Presence of fecal leukocytes or lactoferrin suggest ?

A

Malabsorption disorder

Inflammatory bowel dz

81
Q

Endoscopic exams for chornic diarrhea are perfromed to exclude ?

A

Inflammatory Dz- Crohns, Ulc. Colitis
Microscopic colitis
Colonic neoplasia

82
Q

When are upper endoscopy performed on PTs with chronic diarrhea?

A

Abnormal labs/pos fecal occult suggest small intestinal malabsorptive disorder (Celiac, Whipple)
AIDS to document Crypto/Microsporidia or M Aviumintracellulare infection

83
Q

What further studies can be performed when chronic diarrhea causes are not apparent after the first three standard tests?

A

24hr stool collection quantification of weight/fat
X-ray/CT
Serological Screening for Neuroendocrine tumors
Breath tests

84
Q

Stool samples with weights less than 200-300g/24hrs excludes ? and suggests ?

A

Excludes diarrhea

Suggests functional disorder- IBS

85
Q

Stool samples with weights more than 1000-1500g/24hrs suggests ?

A

Suggests significant secretory process- neuroendocrine tumor

86
Q

Fecal fat exceeding 10g/24h suggests?

A

Confirms malabsorptive order

87
Q

Fecal elastase less than 100mcg/g may be caused by ?

A

Pancreatic insufficiency

88
Q

Abdominal x-ray on a PT with chronic diarrhea showing calcification confirms what Dx?

A

Chronic pancreatitis

89
Q

What antidiarrheal agents can be used in PTs with chronic diarrhea?

A 
Loperamide*
Bismuth subsalicylate*
Diphenoxylate w/ atropine
Codein/Deodorized opium tincture
Clonidine
Bile salt binders
90
Q

What are the signs of an upper GI bleed?

A

Hematemesis- bright red blood or coffee grounds
Melena in most cases
Hematochezia in massive upper GI bleeds
Possible pain- epigastric, abdominal

91
Q

For upper GI bleeds, how is the amount of blood loss determined?

A

Volume status

HcT is poor early indicator

92
Q

What are the four types of GI bleeds?

A

Upper Lower Obscure

Occult

93
Q

What are the essentials of Dx for acute upper GI bleeds?

A

Hematemesis
Varying hypovolemia
Possible melena
Hematochezia in massive bleed

94
Q

What are the etiologies of acute upper GI bleeds?

A

PUD
Portal HTN= esophageal varices
Mallory Weiss tear- strong association with alcohol abuse
Vascular abnormals
Neoplasm
Other- erosive gastritis/esophagitis/Booerhave Synd

95
Q

What is the most common presentation of upper GI bleeds?

A

Hematemesis or melena
Melena from 50-100mL of loss
Hematachezia reqs 1L
Severe upper GI bleeds present with hematochezia in 10% of cases

96
Q

Upper GI bleeding is self limited in __% of PTs while the rest of PTs require?

A

80%

Rest require urgent medical therapy and endoscopic evaluation

97
Q

What type of PT have a low risk of recurrent bleeding?

A

PTs w/ bleeding more than 48hrs prior to presentation

98
Q

Initial eval/treatment for upper GI bleeds?

A

Stabilize- SBP below 100mm or HR above 100bpm= high risk

99
Q

If upper GI bleeds do not need blood transfusion, what next step is considered?
What do you not do?

A

NG tube- useful in assessment and triage
Aspiration of red blood/coffee grounds confimrs upper GI source
NO GASTRIC LAVAGE

100
Q

What meds are given/used for upper GI bleeds?

A

Erythromycin 250mg IV 30min prior to gastric emptying

101
Q

Did not add any cards

A

Below blood replacement of Upper GI BLeed

102
Q

Clinical predictors of increased risk of rebleeding and death include what factors?

A 
\+60y/o
Comorbid illnesses
SBP below 100mm
HR +100bpm
Bright red blood NG aspiration or rectal exam
103
Q

What are the characteristics of the High/Low risk PTs after upper GI triage?

A

High: Admit to ICU, endoscopy performed in 2-24hrs

Low: admitted to step down unit/ward
Non-emergent endoscopy within 12-24hrs

104
Q

PUD ulcers account for __% of major upper GI bleeds with a _% mortality rate
Portal HTN accounts for _%
Mallory Weiss tears ?%

A

40% at 5%
10-20%
5-10%

105
Q

What are the most common cause of vascular anomalies of GI bleeds?

A

Angioectasias- distorted vessesl from chronic/intermittent obstruction of submuccosal veins most commonly in R colon

106
Q

What are the causes of gastric mucosal erosions that can lead to erosive gastritis and upper GI bleeds?

A

NSAIDs
Alcohol
Severe medical/surgical illness

107
Q

What are the steps of care if PT presents as unstable during an upper GI bleed?

A

Start IV
CBC, PT/INR, CMP, Type/Screen
Fluid/blood replacement- isotonic fluid, 2-4 units
NG tube

108
Q

EGDs are warranted for which upper GI bleeds?

A

ALL with active bleeds within 24hrs of presentation

109
Q

What are the three benefits of an ednoscopy in an upper GI bleed?

A

ID source
Determine re-bleed risk
Intervene- cautery, vasoconstrict, band/clip
Homeostasis

110
Q

What is the follow on pharmacotherapeutic care fo upper GI bleeds?

A

PPI- reduce rebleed risk factors

Octreotide- red BP and risk of re-bleed risk

111
Q

What is defined as mild lower GI bleeding?

A

Bright red blood dripping into bowl or is mixed with brown stool
Eval’d on outpatient setting

112
Q

What is the etiology of lower GI bleeds?

A

IBDz- especially ulcerative colitis

113
Q

What are the other S/Sx of lower GI bleeds?

A

Ab pain
Tenesmus
Bleeding from occult to recurrent hematochezia

114
Q

Brown stools mixed/streaked with blood predict the source being where?

A

Rectosignmoid or anus

115
Q

Large volumes of bright red blood suggest a bleeding source where?
What if blood is maroon color?

A

Colonic source

Maroon- lesion in R colon or small intestine

116
Q

Painless large volume lower GI bleeds are indicative of ?

A

Diverticuli bleed

117
Q

What type of lower GI bleed is a colonoscopy the preferred initial study?

A

Acute large volume bleeds requiring hospitalization

118
Q

Treatment for all lower GI bleeds includes?

A

Triage/Stabilization

Blood replacement

119
Q

What are the purposes and perks of a therapeutic colonoscopy?

A

High risk lesions treated endoscopically w/ epinephrine injection/cautery/metal clips or TC-325 powder

120
Q

What is the major common side effect/reaction to a lower GI bleed endoscopy?

A

Ischemic colitis- 5%

Re-bleed- 25%

121
Q

When is surgical treatment indicated for PTs with lower GI bleeds?

What usually causes this type of bleeds?

A

Ongoing bleeds requiring more than 6 units of blood in 24hrs or,
10 total and endoscopic treatment has failed
Caused by bleeding diverticulum or angioectasia

122
Q

Surgical treatment may be a consideration for diverticulum PTs meeting what criteria?

A

Two or more hospitalizations for diverticular hemorrhage

123
Q

Define Anorectal disease

A

Hemorrhoids, fissures; usually cause small amount of red blood on TP or streaking in bowl
Hemorrhoids in 10% of admitted PT w/ lower bleeds

124
Q

Rectal ulcers usually present in what PT population?

A

8% of elderly or debilitated PTs w/ constipation

125
Q

What PT population is ischemic colitis usually seen in?

A

Older PTs with atherosclerotic disease

Younger= vasculitis, coagulation disorder, estrogen therapy, long distance running

126
Q

What S/Sx will a PT with ischemic colitis present with?

A

Hematochezia or bloody diarrhea w/ mild cramps where bleeding is mild/self-limited

127
Q

What does radiation induced proctitis cause after a time delay?

A

Anorectal bleeding revealing telangiectasias

128
Q

What are all of the etiologies of lower GI bleeds?

A 
Diverticulosis
Angioectasias- common +70y/o
Neoplasms
IBDz
Anorectal Dz- hemorrhoid, fissure, ulcer
Ischemic/infection colitis
Other- telangiectasias
129
Q

Bleeding from the small intestines can be ? or ? but manifest as ?

A

Overt or occult

Melena, maroon stools or bright red blood per rectum

130
Q

What is the most common cause of small intestinal bleeds in PTs younger than 40?

A

Neoplasms- stromal tumor, lymphomas, adenocarcinoma or carcinoids
Crohns Dz
Celiac Dz
Meckel Diverticulum

Also occur in PTs +40 but angioectasias and NSAID induced ulcers are more common

131
Q

Define occult bleed

A

Bleeding not apparent to PT, can be less than 100ml/day and not cause any changes in stool

132
Q

How are occult bleeds found in adults?

A

Pos FOBT
FIT- only detects lower bleeds
Fe deficiency anemai

133
Q

What are the most common causes of occult bleeds with Fe deficiency?

A 
Neoplasm
Vascular abnormality
Acid-peptide lesion
Infection
Meds
IBDz
134
Q

Majority of acute lower GI bleeds arise from what part of the GI system?

A

Colon

Lower risk of serious blood loss than upper GI bleed

135
Q

Most likely consideration for PTs less than 50y/o and have lower GI bleeds?

A

Anorectal Dz
IBDz
Infectious colitis

136
Q

Most likely considerations for PTs over 50y/o and have lower GI bleed?

A

Diverticulosis
Malignancy
Angioectasias
Ischemic Colitis

137
Q

Bright red blood = ? source
Maroon color?
Black?

A

Left colon- hemorrhoids, fissures, diverticulitis, IBD, colitis

Sm intestine or R colon

Upper GI

138
Q

Painful defecation/rectal pain means what issues?

A

External hemorrhoids

Anal fissure

139
Q

Abdominal pain/cramps means what types of issues?

A

IBD

Colitis

140
Q

Painless bleeding is caused by ?

A

Internal hemorrhoids

Diverticular bleeds

141
Q

Small volumes of blood loss indicate what issues?

A

IBD- bloody diarrhea

Hemorrhoids

142
Q

What labs are drawn for acute lower GI bleed?

A

CBC
CMP
Anemia is ominous sign, particularly for suspected neoplasm

143
Q

What is the diagnostics testing methods for acute lower GI bleeds?

A

First exclude upper GI source

Anoscopy
Sigmoidscopy
Colonoscopy
Technetium scan
Angiography
Capsule endoscopy
144
Q

What are the treatment methods for acute lower GI bleeds with large volumes of blood loss?

A

Therapeutic colonoscopy- vasoconstrictive band, cautery and clips/bands
Intra-arterial embolization
Surgery- +6 units in 24hrs or ten total

145
Q

Occult GI bleeds must have what lab drawn to check for what?

A

CBC for anemia

146
Q

PTs w/out + FOBT and no anemia= ?

PTs with +FOBT and anemia= ?

A

Colonoscopy

Upper endoscopy and colonoscopy

147
Q

Who normally has no or some peritoneal fluid?

A

Men- o

Women- 20mL depending on cycle

148
Q

What are the two broad categories of ascites?

A

Associated w/ normal peritoneum

Due to Dz peritoneum

149
Q

What is the most common cause of ascites?

A

Portal HTN 2* to CLDz (80% of PTs with ascites)

150
Q

What is the most common cause of nonportal HTN ascites?

A

Infections- TB
Intrabdominal malignancy
Inflammatory disorder
Ductal disruption- chylous, pancreatic, biliary

151
Q

What are the S/Sx of clinical findings for ascites?

A

Inc girth

Pain may be present depending on cause

152
Q

What questions need to be asked to ascites PTs?

A 
Liver dz
ETOH consumption
Transfusions
Tattoos
Injection drugs
Hx of viral hepatitis/jaundice
Born in hepatitis endemic area
153
Q

Fever in a PT with ascites indicates what issue?

A

Infected peritoneal fluid (bacterial)

PTs with CLDz and ascites are at greatest risk for developing spontaneous bacterial peritonitis

154
Q

What type of ascites need to be considered if PT is an immigrant, immunocompromised, or malnourished alcoholics?

A

TB peritonitis

155
Q

Define Budd-Chiari Syndrome and when would it be found?

A

Thrombosis of hepatic vein

During ascites work up/PE

156
Q

What are the lab tests for ascites?

A

Abdominal paracentesis

Routine- albumin/total protein

157
Q

What imaging methods are performed for ascites PTs?

A

Abdominal US

CT/US can distinguish between causes of portal / nonportal HTN ascites

158
Q

When are laparoscopy procedures in ascites PTs?

A

PTs with nonportal HTN ascites (low SAAG)

Mixed ascites

159
Q

What are the etiologies of ascites?

A

Spontaneous bacterial peritonitis
Malignant ascites
Familial Mediterranean Fever

160
Q

Stopped at

A

Etiology of Acites

IPAP (212 decks)

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